Flu shots: Roll sleeves up... if you're elderly

Some people beg for the flu shot each October. Others are petrified of getting one. "Last time I got a flu shot, I was sick as a dog. I almost died!" they say. (I always wondered why we say "sick as a dog" because my dogs have always been healthy.)

I try to convince my patients who think the flu vaccine made them sick that it wasn't the shot that did it. When do we give the flu shot? During cold and flu season! So people get the flu shot and then get a bad cold. Who gets blamed– Mother Nature or the flu shot?

I've played a game with a few patients. To people who need the shot (65 or older, diabetics, HIV+, folks with cardiovascular disease, asthma, chronic obstructive pulmonary disease, kidney failure, cancer) and refuse it, I say, "Let's pretend we gave you the flu shot today. Tell me if you get sick this week."

Usually I get a wry smile: "Sure, doc. Like I'll get sick." Then I have had a high percentage of patients calling me back to say, "Doc, I'm sick as a dog. You're right. It's the cold and flu season. Can I have the flu shot now?"

It's not people's fault if they associate a flu shot with getting sick. It's called classical conditioning: People associate one thing with another because the two occur at the same time.

The danger is that misinformation can lead to serious illness or even death. In the U.S., about 50,000 people every year die and hundreds of thousands are hospitalized. The flu shot doesn't prevent the flu, but it sure takes the sting out of it.

Some people just don't want the flu shot because they've never had the flu. I've talked to patients in their 80s who claim to have avoided every past flu epidemic. When I ask them if there was a time they were bed-ridden with high fevers and cough, it's surprising to hear how many of them say, "Well, come to think of it, there was that time I was on my back for a week."

In a world of drama queens and hypochondriacs, I find it amazing how easily some people erase memories of illness.

This year there's a severe shortage of the flu vaccine. Half of the world supply "flu" away. So those who don't need the flu shot are likely to be turned away. There are two medications that actually stop the flu virus from replicating, but last year during the flu outbreak, there was a shortage of those pills as well. One of our local pharmacies only had enough flu pills for two patients each day. That's like living in Russia.

There's a flu mist that you can inhale. However, the majority of people who need a flu shot can't take the flu mist because only people older than five or younger than 55 can use it– no HIV, diabetes, heart disease, kidney disease, cancer, asthma, etc.

Why make a mist that nobody can take? It's like holding food in front of hungry people, but the food can be eaten only by healthy active people. The flu mist was such a bust last year that my office is not even going to carry it this year. All it did last year was take up space in our freezer.

It's already an interesting year for the flu shot. Patients with rolled up sleeves (like those pictures of Kerry and Bush campaigning) will be lining up for their dose. Unfortunately, some sleeves will have to roll down– down the arms of those who aren't likely to die from catching the flu.